We are seeking a dedicated and detail-oriented appeals coder to review Medicare medical records and determine whether conditions of coverage exist for denied claims. The role focuses on NCD/LCD denials, duplicate denials, and MUE denials, comparing findings to CMS guidelines and preparing uphold justifications when appropriate.
The position initially focuses on FACETS cases with plans to expand to COSMOS cases, and involves handling additional coding-related scenarios as the team grows. The expected volume is approximately 300 cases per week.
Coding certificate such as CPC, CCS, or equivalent
Strong understanding of medical records review
Experience with Medicare appeals and denials, including NCD/LCD, duplicate, and MUE denials
Experience with FACETS; COSMOS experience preferred
Excellent analytical and problem-solving skills
Strong attention to detail and accuracy
Strong written and verbal communication skills
Ability to work independently and as part of a team
Familiarity with CMS guidelines and Medicare policies
Previous experience in a similar role is preferred
Knowledge of healthcare regulations and compliance is preferred
Full range of medical and dental benefits options
Disability insurance
Paid time off, including sick leave
Other paid and unpaid leave options
Location
Atlanta, Georgia, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
3 weeks ago